Payer News in Review 2022 – Special Edition

2022 Notable Payer News in Review

January – Mark Cuban’s Cost Plus Drug Company

Mark Cuban Cost Plus Drug Company (@costplusdrugs) officially launched its online pharmacy [] and is now making deals with insurance companies.

June – Anthem changes name to Elevance Health, Inc. (NYSE Ticker Symbol — ELV) effective June 28, 2022.

Anthem announced that their shareholders voted to approve their parent company’s name change from Anthem, Inc. to Elevance Health, Inc. (@elevancehealth).

July – New requirement for payers – Making pricing information available to the public rule effective July 1, 2022

By plan or policy years beginning on or after January 1, 2023, most group health plans and issuers of group or individual health insurance coverage are required to disclose personalized pricing information for all covered items and service to their participants, beneficiaries, and enrollees through an online consumer tool, or in paper form, upon request. Cost estimates must be provided in real-time based on cost-sharing information that is accurate at the time of the request.

October – The Inflation Reduction Act Lowers Health Care Costs for Millions of Americans

Oct – Medicare will be able to negotiate directly with drug manufacturers to lower the price of some of the costliest single-source brand-name Medicare Part B and Part D drugs.

October – UnitedHealth completes acquisition of Change Healthcare

UnitedHealth Group (@UnitedHealthGrp) said its health services unit has completed the acquisition of Change Healthcare(@Change_HC), ending more than a year of uncertainty due to anti-competitive concerns.

October – CMS cracks down on Advantage TV Ads

The Centers for Medicare and Medicaid Services (CMS) is cracking down on misleading and confusing advertisements for Medicare Advantage (MA) and Medicare Part D prescription drug plans. In the new year, MA organizations and Part D drug plans will not be allowed to air TV advertisements before CMS has approved them, according to Kathryn Coleman, director of the Medicare Drug & Health Plan Contract Administration Group.

December – ACA Enrollment

The Biden-Harris Administration announced that Affordable Care Act (ACA) Marketplace enrollment continues to move at a fast pace–nearly 5.5 million people have selected an Affordable Care Act (ACA) Marketplace health plan nationwide since the start of the 2023 Marketplace Open Enrollment Period.

December – Courts rules against Blue Cross Illinois Discriminated Against Transgender Patients

A lawsuit accusing Blue Cross Blue Shield of Illinois of violating an anti-discrimination provision of the Affordable Care Act by refusing to cover a transgender teenager’s gender-affirming care through an employer plan it administers can go forward as a class action, a federal judge ruled.

December – Humana, TriWest Win $136B in DHA T-5 Tricare Managed Care Support Contracts

Humana (@Humana) and TriWest Healthcare Alliance won $136 billion in contracts from the Defense Health Agency to provide managed care support services for service personnel, retirees and their families in the East and West regions in the U.S. as part of the Tricare program.

December – CMS proposes changes to prior authorizations

As part of the Biden-Harris Administration’s ongoing commitment to increasing health data exchange and investing in interoperability, the Centers for Medicare & Medicaid Services (@CMSGov) issued a proposed rule that would improve patient and provider access to health information and streamline processes related to prior authorization for medical items and services.

December – Blue Cross Blue Shield of Massachusetts Signs Groundbreaking Value-Based Payment Contracts Incorporating Equity Measures

Blue Cross Blue Shield of Massachusetts announced a milestone in its commitment to ensuring access to high-quality, affordable and equitable care. The not-for-profit health plan is the first in Massachusetts – and among the first in the nation – to create a financial payment model rewarding health systems and physicians for eliminating racial and ethnic inequities in care, with a goal of improving health care for all 2.9 million Blue Cross members.

Predictions and Trends

What will health care look like in 2023? Blue Shield Executives Predict a Revitalization

Blue Shield (@blueshieldca) President and Chief Executive Officer Paul Markovich and members of his leadership team predict what’s ahead for the healthcare industry and Blue Shield in 2023.

4 Healthcare Trends for 2023 and How They Will Impact U.S. Employers

The healthcare outlook for early 2023 and beyond has a number of encouraging trends for the employers who provide health insurance to employees and their families. Learn about four top healthcare topics and how they will impact American businesses.

Health Trends Shaping Benefits in 2023

What are some of the key trends that will shape employer-provided healthcare in the coming year and beyond? Mercer Marsh Benefits surveyed 226 insurers across 56 countries for its 2023 Health Trends Survey, which offers some insights.

6 key trends influence employee benefits in 2023

Heading into 2023, employers will have to adapt to economic and social pressures. For many, this will require a reevaluation and restructuring of employee benefits programs, implementing new solutions that manage costs while providing meaningful value to employees.

Affordability a top trend to watch in health for 2023

A heightened focus on affordability is among the seven health and well-being Trends to Watch in 2023, according to Business Group on Health. Other top trends include a greater shift toward health equity and the ongoing need for health and well-being programs that help employees navigate life’s stressors.

Best Health Insurance Companies Of January 2023

Health insurance is vital to your well-being and your wallet, but comparing health insurance companies isn’t straightforward. Forbes (@ForbesAdvisor) evaluated large, small and regional health insurance providers to find the best health insurance companies across the country. See their top picks.